SLU Med Students Who Strive For Perfection More Likely To Have Depression, Study Finds

A survey of first-year St. Louis University medical students found those who described themselves as perfectionists were more likely to experience mental health issues such as depression and anxiety.

The findings, published in February in the journal Academic Psychiatry, show the thought processes that are lauded in high-achieving fields such as medicine can have a serious effect on students’ well-being.

“We then essentially found evidence these toxic thought patterns would contribute to distress and even mental health conditions in medical students,” said survey author Stuart Slavin, the medical school's former associate dean of curriculum.

The survey of 169 students found those who reported having impossibly high standards for themselves were significantly more likely to experience shame, embarrassment and inadequacy than students without. Surveyors found a similar pattern in students who suffered from imposter syndrome, or feelings of not belonging.

The students who reported feelings of shame, embarrassment and inadequacy also were more likely to report mental health problems such as depression or anxiety.

“There’s this fear of if you don’t perform well, then you’re not going to get into the next [program], you’re not going to be able to jump the next hurdle in the next possible way, and your life is going to be forever compromised,” said Slavin, now a visiting scholar at the Accreditation Council for Graduate Medical Education.

Students’ perfectionism likely helped students get into medical school, Slavin said. Getting into a program is a competitive process. The average score on the Medical Colleges Admissions Test is in the 80th percentile of all test-takers, and the average GPA of a medical student was 3.7, according to the Association of American Medical Colleges.

It may be difficult for medical-school students to adjust to an environment in which they’re not among the smartest people, Slavin said. The intellectual and emotional stresses of medical school can lead a student to finally burn out, he said.

Medical schools need to place less emphasis on being the best, Slavin said.

“What I think makes sense is to have a healthy pursuit of excellence, rather than an unhealthy pursuit of perfection,” he said.

Medical schools also need to offer mental health treatment to students and teaching coping skills early in the curriculum before students burn out, programs that SLU put in place during Slavin's time directing the school’s curriculum, he said. Those changes, which also included grading first- and second-year students on a pass/fail scale, brought reported student depression down to 4 percent.

However, the emphasis on perfection begins much earlier than medical school, he said.

"These mindsets aren’t just popping up in medical school; these are being developed early on in the educational system," he said. “No one is perfect, everyone makes mistakes. If we hold ourselves to a standard of perfection, we’re going to cause ourselves problems."

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Saint Louis University’s School of Medicine is removing an administrator who drew national attention for his work to prevent student depression and suicide. The decision comes as the school faces probation by the accrediting body for U.S. medical schools, which gave SLU two years to make recommended changes.

Administrators notified students and staff this week that Dr. Stuart Slavin, the associate dean of curriculum, would be placed on sabbatical “so that he can transition to the next phase of his career.”

During her first year of medical school, Katherine Hu struggled with the feeling that she didn’t measure up.

“You end up becoming, actually, pretty cynical. I’d be sitting in class, the professor’s speaking a million miles an hour, and I don’t know what’s going on,” Hu said. “It just becomes heavier and heavier … kind of hopeless sometimes.”

Earlier this year, the work of Dr. Stuart Slavin, a pediatrician and associate dean for curriculum at Saint Louis University School of Medicine, was featured in a New York Times opinion piece on the stress of students today. Slavin found through an anonymous study at a high school in California that 54 percent of students showed moderate to severe symptoms of depression.

John Dietl knew that his son, Kevin, was experiencing depression. He pleaded with him to get help.

"He did. But he said under one condition; we’ve got to pay cash, and 'I’ve got to go out of town,'" Dietl recalled recently, as he sat at his kitchen table with his wife in Chesterfield. "[He said] 'I can’t let anybody know I’m struggling with this, because it’ll be detrimental to my career.''"

Kevin Dietl, a bright medical student with brown eyes and a passion for water sports, took his life last year, just weeks before he would have graduated from A.T. Still University’s College of Osteopathic Medicine in Kirksville. He was 26.